8 Ways the ACA Could Affect Your Ophthalmology Practice

Leigh Page


September 11, 2013

In This Article

7. Expect More Fraud Investigations of Ophthalmologists

Ophthalmologists can expect more fraud investigations under the ACA, which added $350 million in spending for regulatory enforcement in healthcare over 10 years.

In 2013, for the first time, ophthalmology was identified in the work planof the HHS Office of the Inspector General (OIG),[5] which lists the office's targets for fraud investigations in the coming fiscal year. This heightened scrutiny should continue, because "once you're on the work plan, you'll probably stay on it," according to Brenda N. Laigaie, a partner at the law firm of Wade, Goldstein, Landau & Abruzzo in Berwyn, Pennsylvania.

Laigaie said that the OIG was concerned about recent increases in Medicare payments for ophthalmic services, including injectable drugs for retina patients, premium IOLs, and purchases of the femtosecond laser, which can cost half a million dollars. The work plan noted that Medicare paid more than $6.8 billion for ophthalmic services in 2010.

OIG investigations have become more sophisticated. In Congressional testimony in 2010,[6] the general counsel of the OIG said that the agency had adopted empirical analysis to look for patterns of potential fraud and abuse in claims data, followed by targeted investigations.

8. Industry payments to you will be posted publicly

Pharmaceutical, device, and other companies making payments to physicians have to begin reporting those payments to a federal database that the public will be able to view under the Physician Payments Sunshine Act,[7] also part of the ACA.

The companies have to report payments of $10 or more for consulting, honoraria, gifts, entertainment, food and beverages, travel, research, royalties, and investment interest fees, but speaking engagements at accredited CME sessions that meet certain criteria will not be reported.

Submission of the payment information began in August, and the information will be posted on the Open Payments Website in September 2014. Physicians have 45 days to review the data and dispute the report with the reporting company, plus a 15-day extension to resolve a dispute, before the information is posted.

Laigaie's advice to physicians is to be aware of payments ahead of time. "Keep a tally of what you have been paid and contact the sources if you're not sure," she said.


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